Morbimortalidad en pacientes obesos sometidos a cirugía cardiaca en el hospital universitario puerta del mar de cádiz

Zusammenfassung

INTRODUCTION AND THEORETICAL FRAMEWORK. Obesity is a cardiovascular risk factor that has always been associated with increased morbidity and mortality in surgery. In the case of cardiovascular surgery, it has also been associated with greater morbidity and mortality. However, there are many discrepancies on this statement and several studies even defend the opposite. Mortality is a variable widely used variable in cardiac surgery to measure the results of a cardiovascular unit. The predictive models used in this specialty try to predict or calculate the risk of death that a patient has when undergoing surgery. To do this, these scales include a series of characteristics or risk variables that increase the probability of death. Obesity is a variable that is included in some predictive models and not in others. JUSTIFICATION. This thesis aims for studying the obese population in our setting in the field of cardiac surgery and for clarifying in our center some discrepancies regarding morbidity, mortality and obesity that exist in the current bibliography. The results obtained from our owm center´s analysis, will allow to assess the risk of an obese patient more accurately and more faithfully than any type of external predictive model applied to our patients. This information allows us to more correctly assess the risks of any patient who underwent cardiac surgery at the Puerta del Mar Hospital, since morbidity and mortality information from non-obese patients will also be collected. HYPOTHESIS AND OBJECTIVES. Hypothesis: Patients having body mass index (BMI) equal to or greater than 30 Kg / m2 sometimes undergoing cardiac surgery at the Puerta del Mar hospital in Cádiz have higher mortality in the first year after surgery than patients having BMI less than 30 Kg / m2. The logistic Euroscore I underestimates mortality in patients with a body mass index equal to or greater than 30 kg / m2, sometimes cardiac surgery at the Puerta del Mar hospital in Cádiz. Objectives: To analyze the postoperative complications that appear in obese patients undergoing cardiac surgery at the Puerta del Mar Hospital in Cádiz. To analyze mortality in elective and non-elective surgery in obese patients who underwent cardiac surgery at the Puerta del Mar Hospital in Cádiz. To create a predictive model of own mortality. MATERIAL AND METHOD. Retrospective, independent and unfunded observational study. For this study, epidemiological data from patients undergoing cardiac surgery at the Puerta del Mar hospital in Cádiz between January 1, 2004 and December 31, 2012 were used. The database from which you will obtain the variables for this study was the SICCS Database (Biomenco®, Madrid, Spain) that includes more than 170 variables. The variables collected are both preoperative and postoperative and their analysis includes a binary, univariate and multivariate logistic regression. For statistical analysis, the Statistical Package for Social Sciences version 25.0 (IBM Corp. Launched in 2017. IBM SPSS Statistics v 25.0 for Windows; Armonk. NY. USA) software was used. RESULTS We have a sample of 1018 patients. 678 men and 340 women. The mean age was 65 years old. 369 patients (36.2%) were obese having a mean BMI of 33.8. 70.2% of obese suffered from type I obesity, 23% type II and 6.8% type III. The mean Euroscore I of the sample was 5.56. In exitus group, the mean Euroscore I was 14,06 in non-obese group and 7.82 in obese group. Mortality in the complete sample was 10.2%, mortality in obese group was 11.9% and in non-obese group 9.2%. In obese group, renal failure, prolonged mechanical ventilation, mediastinitis, sepsis, and prolonged stay were 10.6%, 26.3%, 6.5%, 15.4%, and 26.3%, respectively. And 5.4%, 19.9%, 1.8%, 8.2% and 14.9% in non-obese group. DISCUSSION Comparing our results with other articles or series is complicated and difficult to interpret. The results of the other authors are often from populations that may have very different characteristics from ours. Results with conclusions based on quality standards different from ours, in centers (sometimes of excellence or reference) where mortality and complications are lower than what we are used to living in our environment. Postoperative management of a patient having morbid obesity may have minimal difficulty in a hospital and it may have catastrophic results in other hospital. The strength of this thesis lies with the fact that its results are a faithful fact of our activity, and the information and prediction of morbidity and mortality that its analysis has given us is the most authentic and accurate analysis that we can find for our population. CONCLUSIONS. • Obese patients undergoing cardiac surgery in Puerta del Mar hospital in Cádiz did not have higher surgical mortality in the first year than non-obese patients. • In elective surgery there is a trend towards mortality in obese patients. • This trend is justified by the significant increase in mortality in obese women. • Euroscore I underestimates mortality in obese patients undergoing cardiac surgery in Puerta del Mar hospital in Cádiz. • Obese patients have more postoperative complications than non-obese patients. • In our predictive model, obesity is not a risk factor that significantly increases the risk of death. • In terms of mortality, there are no reasons to limit cardiac surgery in obese patients at our center.